Provider Demographics
NPI:1841702370
Name:PETTIT, KRISTEN MARIE (LCPC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:PETTIT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 HARROWSMITH CT
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-2554
Mailing Address - Country:US
Mailing Address - Phone:443-864-2748
Mailing Address - Fax:
Practice Address - Street 1:1814 HARROWSMITH CT
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-2554
Practice Address - Country:US
Practice Address - Phone:443-864-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8185101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor